Clear Lens Phacoemulsification Research Articles

Visual and refractive outcomes after implantation of two models of trifocal intraocular lenses in eyes with previous corneal ablation to treat hyperopia

BackgroundTo assess whether a trifocal intraocular lens (IOL) with neutral spherical aberration (SA) provides better visual and refractive outcomes than a trifocal IOL with negative SA after hyperopic corneal laser ablation.MethodsThis is a retrospective comparative study. Patients were classified according to the IOL implanted after cataract or clear lens phacoemulsification [group 1, PhysIOL FineVision Pod-F (negative SA); group 2, Rayner RayOne Trifocal (neutral SA)]. We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction.Results198 eyes of 119 patients met the inclusion criteria. Group 1 comprised 120 eyes and group 2 comprised 78 eyes. At completion, the refractive and predictability results were significantly better in group 1 than in group 2 for manifest refraction spherical equivalent (MRSE) (P < 0.001). Differences were not significant for UDVA (P = 0.647), CDVA (P = 0.343), UIVA (P = 0.059), UNVA (P = 0.382), binocular UIVA (P = 0.157), or binocular UNVA (P = 0.527). Safety and efficacy indices in refractive lens exchange (RLE) eyes were 0.96 and 0.91, and 0.89 and 0.93 in groups 1 and 2, respectively (P = 0.254 and 0.168). Patient satisfaction was similar in both groups (P > 0.05, all items).ConclusionIn eyes previously treated with hyperopic corneal ablation, implantation of a trifocal IOL with neutral SA provided better efficacy and safety outcomes but worse predictability outcomes than those obtained with a trifocal model with negative SA.

Clear Lens Phacoemulsification with Implantation of Intraocular Lens in a Case of Bilateral Anterior Lenticonus Due to Alport Syndrome

Alport Syndrome (AS) is a rare disorder of basement membrane, which is progressive, hereditary and presents as nephritis associated with sensorineural hearing loss, and ocular abnormalities including anterior lenticonus. Anterior lenticonus secondary to Alport syndrome is difficult to correct, however clear lens phacoemulsification is a successful and safe treatment option for the anterior lenticonus associated with Alport Syndrome. We report visual status of a young patient with Alport Syndrome and bilateral anterior lenticonus, after clear lens phacoemulsification. A 17-year-old male with bilateral anterior lenticonus presented with decreased visual acuity. Systemic evaluation revealed Alport syndrome. Clear lens phacoemulsification and foldable acrylic intraocular lens implantation was done. Visual acuity improved after surgery. There were no notable complications. Clear lens phacoemulsification and foldable lens implantation are effective and safe procedures for individuals with this visual disorder.

Outcomes of primary endoresection for choroidal melanoma

PurposeTo review long time treatment results in patients with small or medium sized choroidal melanoma who underwent surgical tumor endoresection as a primary treatment when plaque radiotherapy was unable and patients declined enucleation.Materials and methodsPatients were evaluated for best corrected visual acuity (BCVA), and underwent biomicroscopy, indirect ophthalmoscopy, retinography and ultrasound as well as the usual systemic workup. Study inclusion required the absence of scleral invasion or metastasis and an anterior margin not exceeding the pars plana or the ciliary body. Surgery consisted of a clear lens phacoemulsification with a PC-IOL, and a 23-gauge pars plana vitrectomy with anterior vitreous shave, lesional choroidal endodiathermy, followed by 23-gauge probe tumor endoresection and continuous endolaser. Patients were followed at post-operative 1 day, 1 week, 1, 3, and 6 months and then every 6 months with a complete ophthalmological exam including ultrasound biomicroscopy and systemic follow-up at 3, 6 and every 6 months thereafter.ResultsFourteen patients with choroidal melanoma were included the study. Pre-operative BCVA ranged from 20/20 to hand motion (HM): 20/20 (n = 2); 20/60 (n = 1); and HM (n = 10). Pathological analysis confirmed the diagnosis of uveal melanoma in all cases. Mean follow-up was 54.5 months (45–66 months) with a final BCVA ranging from 20/60 to HM: 20/60 (n = 1); 20/60 to 20/200 (n = 10); and HM (n = 2). The eye retention rate in our study was 100%. No intraocular recurrence was observed. One patient died 12 months after surgery from metastatic disease.ConclusionEndoresection appears to be an acceptable alternative to enucleation for the treatment of posteriorly-localized uveal melanoma, with excellent local control and eye salvage rates.

Clear lens phacoemulsification for the treatment of pre-acute attack stage of angle-closure glaucoma

Objective To observe the safety and effectiveness of clear lens phacoemulsification combined with intraocular lens (IOL) implantation in treatment of preclinical stage or premonitory stage of the primary angle-closure glaucoma (PACG). Methods The clinical data of 37 eyes of 37 cases with preclinical stage or premonitory stage of the primary angle-closure glaucoma in our hospital from March 2010 to June 2014 were collected. All patients with axial length≤22 mm and the anterior chamber depth (ACD) ≤1.5 mm underwent phacoemulsification and IOL implantation through transparent corneal incision. During operation combined with goniosynechialysis in some patients with peripheral anterior synechiae. The follow-up period was 6 months. The visual acuity, intraocular pressure (IOP) and ACD were observed before and after the surgery. Results All surgeries were performed smoothly with no postoperative complication occurred. The follow-up time was 6 months. The postoperative mean IOP was (15.98 ± 2.48)mmHg(1 mmHg=0.133 kPa). Visual acuity after surgery was improved 1-2 lines in 17 eyes (45.95%) and unchanged in 20 eyes (54.05%). The loss of vision acuity had not occur. Compared with preoperation, the ACD was deepened significantly, the anterior chamber angle was widened obviously and the extent of peripheral anterior synechiae decreased obviously. Conclusion Clear lens phacoemulsification combined with IOL implantation is a safe and effective method for the treatment of preclinical stage or premonitory stage of the primary angle-closure glaucoma. Key words: Glaucoma, angle-closure, primary; Pre-acute attack stage; Clear lens; Phacoemulsification; Lens, intraocular

Clear Lens Phacoemulsification Combined with Vitrectomy to Correct High Myopia: Four Years of Follow-Up

Purpose: To evaluate the outcome, intraoperative and postoperative complications of refractive lens exchange (RLE) by phacoemulsification with posterior chamber intraocular lens (IOL) implantation combined with simultaneous pars plana vitrectomy (PPV) in the management of high myopia. Methods: This prospective study consisted of 45 eyes of 26 patients with preoperative myopia greater than –12.5 dpt. Clear lens phacoemulsification with IOL implantation surgery was combined with PPV. Main outcome measures were best-corrected visual acuity (BCVA), stability of the spherical equivalent (SE) and complications at follow-up. Results: The combined procedure of clear lens phacoemulsification combined with PPV has a favorable outcome with acceptable SE predictability and improvement in BCVA. The postoperative BCVA was 0.67 ± 0.21 compared to 0.15 ± 0.10 preoperatively (p < 0.001). The mean postoperative SE was –1.6 ± 0.9 dpt, showing a significant difference when compared with a mean value of –20.0 ± 5.2 dpt before the operation (p < 0.001). During the follow-up, all IOLs were placed stably in the bag with no capsular tear occurring and only 1 case (2.2%) developed retinal detachment. Conclusion: RLE and implantation of an IOL combined with simultaneous PPV is a reasonable refractive surgery option for middle-aged patients with high myopia.

Clear lens phacoemulsification with monovision for the correction of high myopia

Objective To explore the clinical efficacy of clear lens phacoemulsification with monovision combined with artificial lens implantation for the correction of high myopia.Methods This study included 45 patients ( 90 eyes ) diagnosed as high myopia.The distant and near visual acuity ( VA ) and the dominant eye were examined.All the eyes received binocular phacoemulsification and monofocal intraocular lens ( IOL ) implantation.Monovision correction was chosen for 28 patients ( 11 males and 17 females ).Implantation of IOL was designed to yield a spherical equivalent of -2.0～- 2.5D for the nondominant eye.Full correction was performed on 17 control subjects.Distant and near VA in both eyes and the diopter were followed up for 3 months postoperatively.Results Predicted refraction and ideal distance binocular vision were achieved in all the patients.The mean uncorrected distance binocular VA was( 0.83 ± 0.15 ) in the monovision group and ( 0.81 ± 0.13 ) in the control group ( P ＞ 0.05 ).The mean uncorrected near VA was ( 0.68 ± 0.25 ) in the monovision group and ( 0.38 ± 0.21 ) in the control group ( P ＜ 0.05 ).3 months after treatment,the rate of patients reading without glasses was 78.5％ and 20.3％,respectively ( P ＜ 0.05 ).No retinal detachment and cystoid macular edema occurred 3 months after the treatment.Conclusions Clear lens phacoemulsification with monovision is a safe and effective procedure in the corection of high myopia.The patients do not need to wear reading glasses whenever seeing far or near postoperatively. Key words: Monovision; Phacoemulsification; Clear lens; High myopia

Evaluation of Anterior Lenticonus in Alport Syndrome Using Tracey Wavefront Aberrometry and Transmission Electron Microscopy

To evaluate the efficacy of Tracey wavefront aberrometry (Tracey Technologies, Houston, TX) and transmission electron microscopy for the detection of anterior lenticonus in Alport syndrome. Tracey wavefront aberrometry was used to treat a patient with bilateral anterior lenticonus who had a history of Alport syndrome. For transmission electron microscopic examination, anterior lens capsules were obtained during clear lens phacoemulsification and intraocular lens implantation. Spherical aberrations were the predominant higher-order aberrations in the internal optics of both eyes. The Tracey wavefront aberrometer showed that most of the irregular astigmatism originated from the lenticular portion. Transmission electron microscopy of the specimens showed anterior lens capsules with decreased thickness and multiple dehiscences. Tracey wavefront aberrometry and transmission electron microscopy are effective tools for evaluation of anterior lenticonus in Alport syndrome.

Clear Lens Phacoemulsification with Continuous Curvilinear Capsulorhexis and Foldable Intraocular Lens Implantation for the Treatment of a Patient with Bilateral Anterior Lenticonus due to Alport Syndrome

The case of a 29-year-old man is reported who presented with a gradually progressive, painless decrease in vision over 10 years. Anterior segment examination with a slit lamp revealed anterior lenticonus in both eyes. The patient had previously been diagnosed with bilateral sensorineural deafness, however investigations revealed microscopic haematuria and renal insufficiency that subsequently led to a diagnosis of classical Alport syndrome. Since the patient's quality of vision was severely affected by the bulging anterior lens capsule, surgical treatment was required. Clear lens phacoemulsification with continuous curvilinear capsulorhexis and foldable intraocular lens implantation were performed in each eye 2 days apart. One week after surgery, visual acuity was excellent in both eyes. Clear lens phacoemulsification with continuous curvilinear capsulorhexis and foldable intraocular lens implantation was a safe and effective therapeutic choice in this patient for the management of anterior lenticonus due to Alport syndrome.

Clear lens phacoemulsification in the anterior lenticonus due to Alport Syndrome: two case reports

IntroductionAlport Syndrome has a prevalence of 1 case per 5,000 people and 85% of patients have the X-linked form, where affected males develop renal failure and usually have high-tone sensorineural deafness by age 20. The main abnormality is deficient synthesis of type IV collagen, the main component of basement membranes. Common ocular abnormalities of this syndrome consist of dot-and-fleck retinopathy, posterior polymorphous corneal dystrophy, and anterior lenticonus, but other ocular defects such as cataracts, posterior lenticonus, and retinal detachments have also been reported.Case presentationWe report two cases of anterior lenticonus due to Alport Syndrome and describe clear lens phacoemulsification and foldable intraocular lens implantation as an effective and safe refractive procedure in the four eyes of these two patients.ConclusionAll four eyes of the two patients were in good condition after surgery and achieved satisfactory optical and visual results and had no remarkable complications at six-months follow-up. Clear lens phacoemulsification with foldable intraocular lens implantation can be used as an efficient and safe procedure for vision disorders in these patients.

Phaco‐vitrectomy for macular holes

Editor, We would like to congratulate Theocharis et al. (2005) on their paper on combined phacoemulsification and pars plana vitrectomy for macular hole treatment. It supports our pilot study published in this journal 5 years ago (Simcock & Scalia 2000). Tornambe et al. (1997) suggested that prone posturing might not be required for hole closure and also performed combined phacoemulsification with vitrectomy. We perform combined surgery and limit the duration of prone posturing depending on the size and duration of the hole (Simcock & Scalia 2001). Patients with stage 2 holes of short duration are only advised to avoid lying on their backs, while patients with large stage 4 holes of long duration are advised to remain prone for 5 days (if they wish to proceed with surgery given the limited potential for visual rehabilitation in these patients). We have also noted a high proportion of intraoperative retinal tears during posterior hyaloid peeling but the excellent visualization of combined surgery coupled with a wide-angle viewing system facilitates the recognition of the tears and their treatment with laser. The inevitable development of cataract following vitrectomy has changed our practice in other areas of vitreoretinal pathology. Presbyopic patients have already lost their ability to accommodate and exchanging their crystalline lens for an intraocular lens is of no detriment. We now routinely perform combined phacovitrectomy surgery in presbyopic patients even in the absence of significant cataract (Ling et al. 2003). This has all the advantages of the combined surgery in macular hole patients with good visualization, including larger gas fills that reduce the need for buckling in patients with retinal detachment, and prevents the patient having to return for technically difficult cataract surgery. We would not advise combined surgery (unless there is visually significant cataract) in diabetes patients with active retinopathy, ongoing uveitis or non-presbyopic patients. It is also our experience that in difficult cases requiring extensive buckling, laser or oil when combined with clear lens phacoemulsification, excessive anterior segment inflammation with fibrin formation often results. Patients with proliferative vitreoretinopathy who need extensive buckling and/or oil should have the lens removed as a secondary procedure, often combined with oil removal (Simcock 2005).

Clear lens phacoemulsification for correction of high myopia

Purpose To assess phacoemulsification and posterior chamber intraocular lens (IOL) implantation as an effective, safe, and predictable technique for the correction of high myopia. Setting University Eye Clinic of Verona, Verona, Italy. Methods A series of 25 eyes with myopia higher than –12.0 diopters (D) had clear lens extraction by phacoemulsification and IOL implantation in the capsular bag. The mean postoperative follow-up was 42.92 months ± 3.76 (SD). Results No serious intraoperative complications occurred. Uncorrected visual acuity improved in all cases. The mean postoperative best corrected visual acuity improved by an average of 1 line. One case (4.0%) of postoperative retinal detachment (RD) occurred at 12 months. One case (4.0%) of biometric error (3.0 D) occurred. Conclusion Clear lens extraction by phacoemulsification and IOL implantation in a series of highly myopic eyes was effective and had an acceptable predictability and a low rate of complications. Careful evaluation of the retinal periphery by indirect ophthalmoscopy is recommended to avoid postoperative RD.

Phacoemulsification and Opaque Intraocular Lens Implantation for the Treatment of Intractable Diplopia

Intractable diplopia secondary to paralytic strabismus may be treated with the occlusion of the affected eye. Established treatments include occlusion with a patch, opaque spectacles or contact lenses, and performing upper lid lowering procedures or tarsorrhaphies. Two cases are presented in which intractable diplopia was resolved by performing clear lens phacoemulsification and the insertion of an opaque intraocular lens. Both patients reported a resolution of their diplopia having been dissatisfied with other forms of treatment. Although opaque intraocular lens insertion is not recommended as the initial treatment of choice in such cases, it offers a valuable treatment option for those patients in whom other forms of therapy have failed.